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PubMed1986

A rational approach to the investigation of the gallbladder.

A technique for the investigation of suspected non-acute gallbladder disease is described. It is based on properly conducted oral cholecystography (OCG) augmented, when necessary, by ultrasonic examination of the gallbladder (UCG) during the patient's same visit. This regimen has been applied successfully for 5 years; the results of a recent year's work are presented and discussed. Only 12.2% of patients required both investigations and, using the OCG technique described, in only 1.1% of cases was the gallbladder inadequately opacified when subsequent UCG was normal. This approach involves no increase in work-load and provides the referring clinician with objective evidence of the presence or absence of disease following a single visit by the patient to the X-ray department.

Adolescent↗

PubMed1993

Case report: imaging of a bilobed gallbladder.

Imaging of the gallbladder demonstrates a wide range of anatomical variants, including anomalies in location, number and shape. Duplication anomalies are quite rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the two lobes, and on the number and disposition of the cystic ducts. We present a case of a deeply cleft, bilobed gallbladder imaged by computed tomography (CT), ultrasonography (US) and oral cholecystography (OCG). The anomaly consisted of complete duplication of the body and fundus into two distinct and separated lobes both of which entered a single infundibulum. Awareness of congenital gallbladder variants may help in recognizing and correctly classifying gallbladder abnormalities, thus preventing misdiagnoses.

Adult↗

PubMed1979

Improved oral excretory cholecystocholangiography.

A new improved technique for the visualization of intrahepatic bile ducts with oral contrast agent has been developed. The right lateral decubitus position was employed to avoid drainage of contrast medium from the common bile duct into the duodenum. 0.2-0.3 microgram/kg of Caerulein was injected intramuscularly (350 cases) or 0.02 microgram/kg of Kinevac was injected intravenously (15 cases) to induce rapid contraction of the gallbladder. The extruded contrast medium, which would normally flow into the duodenum, flowed backward into the intrahepatic bile ducts due to gravity. With this technique, improved visualization of intrahepatic bile ducts was achieved with use of oral contrast medium; it also obviated the problem of colonic gas overlapping the gallbladder and gallstones in cholecystography.

Administration, Oral↗

PubMed1978

Computed tomography of the gallbladder.

Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.

Cholecystography↗

PubMed1983

Acute calculous cholecystitis with patent cystic duct.

In the diagnosis of acute cholecystitis, the interpretation of cholescintigraphy is usually not difficult. It is conceivable, however, that with unusual location of obstructing calculi atypical images could result. Three cases were studied with cholescintigraphy and one with cholecystography in which more distal locations of obstructing calculi resulted in partial visualization of the gallbladder and erroneous interpretations were possible. Nuclear medicine radiologists should, therefore, be aware that atypical gallbladder images may be the result of unexpected location of obstructing calculi. Clues for assisting in interpretation are offered.

Acute Disease↗

PubMed1975

Studies in cholestasis of pregnancy. V. Gallbladder disease, liver function tests, serum lipids and fatty acid composition of serum lecithin in the non-pregnant state.

Women from an earlier series of cholestasis of pregnancy (CP) were called for a retrospective study to consider presence of gallstones in the gallbladder (evaluated by cholecystography), liver function tests, serum lipids and lipoproteins and the relative fatty acid composition of serum lecithin (as determined by GLC). The attendance in the retrospective study was 60%. Estimated on the total series (assuming that none of the non-responders would have a positive X-ray), the incidence of gallbladder disease was 23.7%. Among women with previous cholestasis of pregnancy and with a positive X-ray finding no characteristic changes in liver function tests or serum lipids were revealed. The women with positive X-ray had, however, a lower alpha-lipoprotein cholesterol than women with negative X-ray. A characteristic finding among women with positive X-ray was furthermore the low relative content of palmitic acid (16:0) in serum lecithin. Also women with negative X-ray had a lower relative content of palmitic acid than controls. It is suggested that the low palmitic acid content is expressive of an influence on liver lecithin synthesis pathways and that the serum lecithin fatty acid composition reflects similar changes in bile lecithin. The "basic defect" in CP influencing liver lecithin synthesis might be the primary cause for disturbed cholesterol solubility in bile and of the frequent occurrence of gallstones in CP.

Adult↗

PubMed1985

Ultrasonographic screening for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features.

Five hundred and forty-seven middle-aged women, selected at random from the population of Malmö, Sweden, were invited to a screening survey for gallstone disease; 424 participated (77.5%). Forty-one had previously been operated on for gallbladder disease. The prevalence of gallstone disease, on the basis of a positive finding at ultrasonography and cholecystography, was 11%. The predictive value of a positive finding at ultrasonography was 86%. Six out of 10 women with gallstone were classified as asymptomatic. Body weight, blood pressure, liver enzymes, fasting blood glucose, and blood lipids, including apolipoprotein-A, did not differ significantly in women with and without gallstone disease. At least 9 out of 10 gallstones appeared to be cholesterol stones. Approximately half were of a size that would make them accessible for dissolution therapy.

Cholecystography↗

PubMed1996

Expectant management of patients with gallbladder stones diagnosed at planned investigation. A prospective 5- to 7-year follow-up study of 153 patients.

BACKGROUND: Few studies have been done on the expectant management of patients with cholelithiasis diagnosed by planned investigation, and results are conflicting. METHODS: A prospective 6-year follow-up study of 153 patients with cholelithiasis diagnosed by oral cholecystography was carried out. RESULTS: An acute gallstone complication occurred during the follow-up period in 23 patients (15%)-that is, acute cholecystitis (n = 18), acute pancreatitis (n = 2), and jaundice (n = 3). The annual risk of developing an acute biliary complication was 3.1%. A history of a gallstone complication predicted further gallstone complications during follow-up. The overall cholecystectomy rate was 20 % during the 1st year but fell to about 3% during the 5th year of follow-up. Young age and frequent attacks of biliary pain episodes predicted the need for gallstone surgery. CONCLUSIONS: Expectant management of patients with electively diagnosed cholelithiasis may be justified, especially in those with only occasional biliary symptoms and no history of gallstone complications.

Acute Disease↗

PubMed1985

Sonographic diagnosis of bicameral gallbladders: a report of three cases.

Three cases of bicameral gallbladder are reported; the fundal chamber could be visualized by oral cholecystography in only one of these cases. However, all structures were well visualized sonographically. Ultrasonography is thus regarded as essential for the diagnosis of bicameral gallbladders and for detecting any calculi within them.

Aged↗

PubMedDate not supplied

[Gallstones in children. Report of one case and review of the literature (author's transl)].

A 12 year old boy is presented with choleithiasis and cholecystitis diagnosed by oral cholecistogram and intravenous cholangiogram and managed surgically with a cholecystectomy. A review of 667 cases of cholelithiasis in children is presented from literature, since the first report of gallstones in 1737, until 1975. It is showed that childhood cholelithiasis is a uncommon disease, occurring in all ages but (commoner) in preadolescent and adolescent girls. Etiologic significance of obesity, family history of cholelithiasis, pregnancy and history of previous abdominal surgery is reported. Haemolytic disease is an underlying etiologic agent in less than 19% of 416 cases reviewed. A high percentage of gallstones were visible on plain films of the abdomen and oral cholecystograms were diagnostic of cholelithiasis or showed changes highly suggestive of gallstones in 86% of cases reviewed. In a child with abdominal pain of unknown etiology, it is imperative to exculade the possibility of gallstones, and plain films of the abdomen and oral cholecystography are the best investigative techniques to do this.

Age Factors↗

PubMed1975

Trends in surgical treatment of calculous disease of the biliary tract.

From the data presented, there are five distinct trends in operations for calculous biliary tract disease. There is less delay in operation following diagnosis than ever before. Diagnosis is being made early in those with symptoms. Asymptomatic calculi are being revealed more frequently by complete over-all medical evaluations including cholecystography. Acute obstructive cholecystitis, a complication of cholelithiasis, is becoming less frequent in proportion to the total patients admitted to hsopitals. The operative mortality is concentrated among those in the elderly group, 65 years old and older. The limited capacity of many patients in this category to tolerate the burden of any surgical procedure is being met by palliative, temporary procedures such as cholecystostomy and ductal decompression rather than definitive cholecystectomy and choledochotomy. Roentgenologic facilities are becoming available to provide visualization and critical evaluation of the entire ductal system at the beginning of an operation. This provides a more realistic basis for common duct exploration, an increment associated with morbidity. More important is the assurance against overlooking calculi, retained ductal stones.

Age Factors↗

PubMed1975

Assessment and treatment of recurrent peptic ulceration.

From the experience of treating 91 patients with a proven recurrent ulcer we consider that if a proven ulcer is shown to be present and a gastrin-secreting tumour is excluded an appropriate reoperation will almost always produce a successful result (94 per cent). Before subjecting patients to reoperation all attempts must be made to secure a precise diagnosis. The following investigations should be performed: barium meal, panendoscopy of the upper gastrointestinal tract, determination of maximum acid output (with insulin test and gastrin analysis if appropriate), and cholecystography. Before accepting a diagnosis of recurrent ulcer at least 2 of the first 3 tests should be postive. If the primary operation was a resection we advocate vagotomy alone as the second operation, provided there are no local complications such as stenosis, bleeding, or fistula. If the primary operation was a vagotomy and the recurrence is associated with a positive response to the insulin test we advocate revagotomy and antrectomy. If the insulin test is negative we normally repeat the test; if it is still negative then we use antrectomy alone.

Barium Sulfate↗

PubMed1975

[When cholangiocholecystography should and should not be performed].

Little-know contraindications for i.v. cholangiocholecystography with water-soluble hexaiodated contrast media are presented. Particular reference is made to suspected cholecystic lithiasis and dysprotidaemic patients or those undergoing treatment with sulphamides, salicylic acid, barbiturates, etc. Lastly, reference is made to the suitability of cholegraphy in suspected acute cholecystitis. Here, in fact, this method is preferable to oral cholecystography.

Biliary Tract Diseases↗

PubMed1975

[Gallstones in childhood-special problems in diagnosis (author's transl)].

Several pediatric textbooks mention hemolytic anemia as the most frequent cause of cholelithiasis. However cholesterol containing concrements seem to be more frequent. In lack of jaundice the diagnosis of gallstones is difficult, especially, when appearing as uncharacteristic abdominal pain. In a case of a ten year old girl the basic diagnosis of cholelithiasis lasted two years. Wrong diagnoses (appendicitis, duodenal ulcer) associated diseases (carditis, complete heart block) and minor troubles (menarche, oxyuriasis, constipation) were responsible for this long period. Oral cholecystography brought on definitive diagnosis. Liberal indication of this investigation is recommended, especially in corpulent girls.

Anemia, Hemolytic↗

PubMed2002

[Age characteristics of the bile duct system functioning in the norm and in the gastrointestinal system pathology].

At the present the age-specific particularities of many organs and systems used in diagnostics are determined. The function--morphological state of the biliary system in different age groups is poorly studied. The age-specific particularities of biligenesis in norm (control group--90 persons) and in pathology were studied by the following traditional methods: multifractional chromatic duodenal catheterization, dynamic scintigraphy of gallbladder, dynamic ultrasonic cholecystography. There were 167 patients with gastroduodenal diseases (chronic gastritis, gastric, duodenal and intestinal ulcers) and 115 patients with calculous cholecystites and chronic hepatites. The gastroduodenal affections reinforced the appearnce and the course of typical age alterations of biliary system. Patients sufferin from hepatobiliary pathology over 5 years biliation ability has remained in normal values.

Adult↗

PubMed1975

Acute cholecystitis in children.

Data from retrospective review of 16 patients treated for acute cholecystitis indicate that the cause of this disease is different in children than in adults. The incidence of acute acalculous cholecystitis is higher in children. Congenital abnormalities of the gallbladder or bile ducts were not found in our patients. Cultures of the bile failed to establish a relationship with preceding infection, although infection seems to be an important etiologic factor. Diagnosis should be based on clinical signs and cholecystography. Early cholecystectomy is the treatment of choice. In patients with jaundice, operative choledochography is recommended.

Acute Disease↗

PubMed1976

A diagnostic technique for acalculous cholecystitis.

Routine oral cholecystography with Telepaque frequently will show normal visualization of the gallbladder in the presence of acalculous cholecystitis and cholesterolosis. Roentgenograms of the abdomen that show persistent opacification of the gallbladder 36 hours after the administration of Telepaque are suggestive of cholecystic disease. Twenty-six patients with previously normal cholecystograms but with continuing symptoms of biliary tract disease were studied with 24 hour delayed films of the gallbladder. All had persistent visualization of the gallbladder, and all had diseased gallbladders verified at operation and by pathologic examination.

Cholecystitis↗

PubMed1958

Biliary tract anomalies: the utilization of modern techniques in differential diagnosis.

The diagnostic aids used in dealing with biliary disease in adults were applied to the study in infants of the principal congenital anomalies of the biliary tract such as choledochal cyst, biliary atresia and biliary stenosis. Choledochal cysts were distinguished from other upper abdominal masses occurring in childhood by the use of intravenous cholecystography. Since the clinical manifestations in infants with biliary atresia or stenosis are almost identical to those associated with the obstructive phase of neonatal hepatitis, the problem of differentiation is difficult. The serial total serum bilirubin curve, a careful analysis of the pigment content of feces and urine and duodenal intubation for bilirubin determinations were found to be useful in making the distinction. Operative cholangiograms were helpful in some cases. Frozen section examinations of liver tissue during operation were of little value except to demonstrate certain unusual cases of intrahepatic biliary atresia. Routine liver function studies, including serum transaminase determination in a limited number of cases, did not help in differentiation.

Biliary Atresia↗